25 August - 10 September 2002
The current rate of malnutrition 6-10% with aggravating factors according to the government guideline for emergency nutrition assessment indicates a poor situation. To avoid a further deterioration of the situation food distribution needs to be increased and proper targeting followed.

1.0 Introduction

1.1Description of survey area

Alaba special woreda is in K.A.T zone of SNNPR. The woreda is one of the largest woreda made up of sixty-seven farmers associations. Total population is 132,938. Altitude ranges are 1750 -2200 meters above sea level. The woreda is 57% lowland and 43% mid highland. Total area of land suitable for agriculture is 41, 090 hectares (source woreda MOA). The population is mainly dependant upon agriculture, with maize as the main cereal grown. Cash crops include pepper and chat

Map of North Alaba special woreda

Shortage of rainfall, land degradation and lack of agricultural inputs are the main constraints to production. Malaria is also the major health problem in the area specifically in the planting and harvesting season.

The belg and meher rains are equally important in the woreda. The belg rains are mainly used to plant long maturing crops, to start land preparation for meher and for generating pasture and improving water availability for livestock. However, the main harvest comes from the meher.

Normally the belg rains start in February, but were delayed by at least 3 weeks this year. The overall distribution quantity and quality of the rains was poor for planted crops especially maize.

This survey was undertaken jointly by SC (UK) and Federal DPPC staff in response to a request made by the SNNPR DPPB, to address the food shortage problems reported by the Woreda officials. Since this survey is the first of its kind in the Woreda, data are not available for comparison purposes.

The following results are indicative of the situation in Alaba special woreda representing both the lowland and mid highland farmers associations.

1.2 Survey Objectives

The survey objectives were to:

• Estimate the prevalence of acute malnutrition in Alaba special woreda
  
  
• Estimate retrospective mortality rates in the 3 months prior to the survey
  
  
• Understand the current causes of malnutrition
  
  
• Estimate the measles vaccination rate.
  
  
• If necessary, make recommendations for intervention in the lowland highland areas of the Zone.

2.0 Methodology

2.1 Survey Methodology

A two stage 30 by 30 cluster approach based on a population-sampling frame of all households in the in the woreda was employed. Children aged 6 - 59 months were selected for measurement. Eight teams collected data over a 15-days period from August 25 to September 10/ 2002.

2.2 Sampling procedure and sample size

The smallest administrative unit was considered to be the farmers association. The Bureau of Agriculture provided population figures. The cumulative population was calculated and sampling interval determined. Thirty clusters were randomly selected by assigning probability proportional to population size in both lowland and highland areas.

The sample size was calculated using EPI-INFO and was based on an estimated prevalence of 20% global malnutrition in children aged less than 5 years, a precision of +/- 5%, 95% confidence limits and a design effect of two. This number was rounded up to 900 with 30 children measured in each of 30 clusters. A total number of 904 children were considered for analysis.

2.3 Training and piloting

Training was provided for eight survey teams (24 team members). The eight-team leaders were SC (UK) and DPPC nutrition staff who had been involved in previous nutritional surveys. A pilot survey was conducted during which each team was supervised by SC (UK) staff.

Training was provided by SC (UK) in the following areas:

• Survey design
• Anthropometric measurements
• Recognition of malnutrition signs and symptoms
• Data collection and interview techniques

2.4 Selection of households and children

So that the teams did not have to walk the entire way across each farmer association before starting a cluster, a list of the names of the localities (villages) in each farmer association was obtained from the farmer association leaders as soon as a team arrived in the FA. localities were then chosen randomly from this list.

The center of the localities was located as the starting point in each cluster. A direction was selected randomly and houses in this direction to the end of the localities were counted. One house was randomly selected and every subsequent nearest household was visited.

All children aged 6 - 59 months were measured. If the child's age was unknown it was measured if its height was between 65-110cm. absent children were followed up with a second visit. All children in the final household were measured.

2.5 Data Collected

2.5.1 Children's data

Anthropometric data

• Nutritional Indicators - Weight for height and/or oedema were used as the indicators for moderate and severe malnutrition.
  
  
• Age - Children between 6 - 59 months were measured. Only children under 110cm (proxy for 5 years) and over 65cm (proxy for 6 months) were measured
  
  
• Weight - A 25kg Salter spring scale was used for children. Weight was recorded to the nearest 100g.
  
  
• Height - All children were measured lying down on a wooden height board. Length was recorded with 0.5cm precision. In the analysis, one cm was removed from the length of children who were more than 85cm to estimate height.
  
  
• Oedema - The presence of nutritional oedema was determined by pressing both feet for three seconds. If a shallow print remained in both feet it was recorded as positive oedema.

Retrospective morbidity of children

Mothers were asked whether or not their children had been sick in the fifteen days prior to the survey. Sickness was defined as diarrhea (loose stools more than 3 times per day), cough (coughing or difficulty breathing), fever, measles or "other".

Vaccination Status and Coverage

The presence of a vaccination mark was recorded as positive for BCG vaccination. A completed vaccination card for measles was recorded as positive for measles vaccination. If a child did not have a card, mothers were asked to confirm whether or not their children had had a measles vaccination.

2.5.2 Mortality data

The number of deaths during the three months prior to interview was recorded retrospectively for all households. Crude mortality and under 5 mortality rates were calculated using household data information from the survey. Cause of death was recorded if known.

2.5.3 Household and key informant questionnaires

The SC (UK) nutritionists and nutrition workers developed household and key informant questionnaires based on the background information from Alaba special woreda. The questionnaires focused on possible causes of malnutrition in the zone and zonal data on food security, health, care and relief were obtained. Data were both qualitative and quantitative. Every third house was asked the household questionnaire (including those without children). These questionnaires provided the basis for food security analysis. See Annex I for the questionnaires. Interviews were also held with the Zonal Council office, Bureau of Agriculture, relief and health officials.

2.6 Data analysis

Initial analysis was done by hand. Further analysis was conducted using EPI-INFO version 6.04b. Team leaders, in conjunction with the SC (UK) nutritionist, were responsible for the analysis, the writing of the report and making recommendations.

(pdf* format - 267 KB)